topiramate, Topamax (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
STORAGE: Topiramate tablets should be stored at room temperature, 15 C to 30 C (59F to 86 F). Sprinkle capsules should be stored at or below 25 C (77 F).
PRESCRIBED FOR: Seizures may be classified as either partial if they involve only a small portion of the brain or generalized if they involve more of the brain. Topiramate is used alone or in combination with other anti-seizure drugs to treat individuals 2 years old or older with partial seizures or generalized tonic-clonic seizures (in which there is prolonged contraction of the muscles of the body that causes rigidity as well as jerking motions). Topiramate also is used in patients 2 years of age and older with seizures associated with the Lennox-Gastaut syndrome, a severe form of epilepsy which accounts for up to 10 percent of all cases of childhood epilepsy. Children with Lennox-Gastaut syndrome experience delays in their development and up to dozens of different, mixed types of seizures a day. The most common types of seizures in this syndrome are tonic (stiffening of the body, with the eyes rolling upwards, dilation of the pupils and shallow, irregular breathing), atonic (brief loss of muscle tone and consciousness, causing abrupt falls), myoclonic (sudden muscle jerks), and absence (staring spells).
Topiramate also is approved for the prevention of migraine headaches in adults.
DOSING: Most commonly, topiramate is started in low doses, 25 or 50 mg per day, and then increased slowly by 25 to 50 mg per week until an effective daily dose is reached. For children 10 years or older and adults the dose may be increased by 100 mg in week 5 and 6 when topiramate is used alone. This slow approach to treatment reduces side effects. The recommended final adult dose is 200-400 mg administered as two divided doses daily.
In children, the starting dose is up to 25 mg (1 to 3 mg/kg/day), taken nightly for the first week. The dose is then increased at 1 or 2 week intervals by 1 to 3 mg/kg/day administered in two divided doses. The target dose is 5 to 9 mg/kg per day in two divided doses.
Migraine is treated 25 mg nightly for the first week then increased by 25 mg weekly up to a maximum dose of 100 mg administered in two divided doses.
Patients should maintain an adequate fluid intake in order to minimize the risk of kidney stones.
DRUG INTERACTIONS: The following medications, when taken with topiramate, increase the risk of kidney stones and metabolic acidosis: acetazolamide (Diamox), dorzolamide (Trusopt), methazolamide (Neptazane), dichlorphenamide (Daranide).
Carbamazepine (Tegretol) and phenytoin (Dilantin) markedly decrease the amount of topiramate in the body by increasing its elimination from the body. As a result, topiramate may lose effectiveness unless doses are increased.
Medically Reviewed by a Doctor on 8/8/2013
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